Were the rich just as likely to catch diseases as the poor? Prince Albert married Queen Victoria in 1840 and they had nine children, but in December 1861 he fell ill and died. Prince Albert had caught TYPHOID, a disease that is caused by drinking either dirty water or milk, or eating dirty food. The usual cause of typhoid was allowing drinking water to be polluted by sewage.

The death of her husband was a great shock to Queen Victoria. How could one of the most important people in Britain die from a disease like this? Was this common? Were rich and poor just as likely to die from diseases like this at the time of the Great Exhibition?

The big killer disease of the mid-nineteenth century was CHOLERA which was caused in a similar way to the disease Prince Albert had died of. Cholera had arrived in Britain for the first time in 1831, probably arriving on ships bringing imports from China.

Doctors had little idea about the causes of cholera. Most accepted the miasmatic (read on!) theory of disease. They believed that diseases were caused by the air somehow being polluted by waste. This came about because severe outbreaks of disease often happened in hot summers when there was a great deal of rubbish lying in the streets. As the rubbish rotted, it gave off a stronger and stronger smell. This, many doctors believed, caused disease. Cholera was most dangerous in the new industrial towns of the north or in the centre of big cities like London. Here people lived in crowded housing. Most people got their water from a tap in the street and often the supply was pumped out of a nearby river. This river could easily be used for sewage disposal at the same time. In London, one water company drew water out of the River Thames from a point right next to the outlet of the Great Ranelagh Sewer.

In the new industrial towns, cholera was even more dangerous because many of the houses had been built quickly with no attempts at planning. Often there was no sanitation and no fresh water. In one street in Bolton the people used a trench at the back of the houses as a toilet, which was cleared out and the mess stacked up against the end wall of the last house. The mess was taken away every six months.

There was a second big outbreak of cholera in 1848, a third in 1853 and a fourth in 1866. Each time thousands of people died swiftly and in terrible pain. They suffered violent vomiting and diarrhoea, coupled with very bad stomach pains. The actual cause of death was often dehydration (not enough water). In 1842 Edwin Chadwick published his ‘Report on the Sanitary Conditions of the Labouring Population of Great Britain’. He had surveyed different areas around the country and calculated the average life expectancy of people from different classes and areas. The results were startling to say the least.

Chadwick claimed that people living in the countryside lived far longer than people in towns. He compared Rutland, a rural county with no large towns, with the new industrial cities of the north.

| Average life expectancy | professional trades | tradesmen | labourers | |-------------------------|---------------------|-----------|-----------| | Rutland | 52 | 41 | 38 | | Leeds | 44 | 27 | 19 | | Liverpool | 35 | 22 | 15 | | Manchester | 38 | 20 | 17 | | Bolton | 34 | 23 | 18 | Chadwick's report led to the setting up of a Royal Commission and then to the Public Health Act of 1848. He became one of the Commissioners.

Unfortunately many people found Chadwick rather rude and he often provoked opposition. In 1854 he was forced to retire. This letter was sent to 'The Times' to explain why he was unpopular.

'We prefer to take our chance with cholera than be bullied into health. There is nothing a man hates so much as being cleansed against his will or having his floor swept, his hall whitewashed, his dung heaps cleared away and his thatch forced to give way to slate. It is a fact that many people have died from a good washing.'

**John Snow (1813-1858)**

John Snow was the eldest son of a farmer and born at York on 15th March 1813. He was educated at a private school in York until the age of fourteen, when he was apprenticed to a surgeon living at Newcastle-on-Tyne. He worked as surgeon in the mines and later as unqualified assistant during the cholera epidemic of 1831-2. Snow continued his medical training in London. In October 1838 he became a licentiate of the Society of Apothecaries, having been admitted a member of the Royal College of Surgeons of England in May 1838. He graduated as an M.D. of the University of London on 20 December 1844, and in 1850 he was admitted a licentiate of the Royal College of Physicians.

Snow's great breakthrough theory was that cholera spreads through means of an impure water supply. He outlined his ideas in an essay about the communication of cholera which was published in 1849, and awarded a prize by the Institute of France. In 1855 a second edition was published, with a much more detailed investigation into the water supply in certain districts of South London during in the epidemic of 1854.

Snow was also interested in the properties of ether, then newly adopted in America as an anaesthetic. He made great improvements in the method of giving patients the drug. He obtained permission to demonstrate his results in the dental out-patient room at St. George's Hospital surgery which was highly successful. Nevertheless, Snow appreciated the value of other anaesthetizing drugs, notably chloroform. He gave this to Queen Victoria on 7 April 1853, during the birth of Prince Leopold, and again on 14 April 1857 at the birth of Princess Beatrice. Snow died unmarried on 16 June 1858, and was buried in the Brompton cemetery. Source 1

Task

1a Why has the letter been written?

1b What had happened in the hospital?

1c Would the treatment received in the hospital have helped to stop cholera spreading? This is a letter written on 5th January 1832. It was sent from the Board of Health to the Newcastle Board. The writer is talking about conditions in Gateshead hospital.

Sir,

The highly inadequate and improper state of the temporary hospital appropriated for the relief of Cholera Patients in the Township of Gateshead, has been reported to the B of Health with an agitation that five children were actually placed in one bed, and three in another bed in that hospital. I am directed by the B to require that you will state with as little delay as possible every circumstance connected with such a want of humanity, which if found in truth must prove highly disgraceful to the members of that B.

Yours,

W. Maclean

(PRO ref: PC 1/93)

http://www.learningcurve.gov.uk/victorianbritain/healthy/source1.htm Source 2

Task

2a How many new cases were reported?

2b How many of the deaths were reported?

2c How many cases of cholera were there altogether?

2d How many people had died?

2e Approximately what percentage of people who caught cholera actually died from the disease? These are the minutes of a meeting of the Board of Health held on 13th January 1832. It includes a report of the numbers of cases of cholera in Sunderland, Newcastle and Gateshead.

(PRO ref: PC 1/105) http://www.learningcurve.gov.uk/victorianbritain/healthy/source2.htm 3a What is the poster saying it can help prevent?

3b The poster gives advice on how to avoid getting cholera. Some advice is good, some is bad. i) Write down three good pieces of advice. ii) Write down three bad pieces of advice (choose the worst!).

3c What else is the poster offering apart from advice?

3d The poster suggests two things that can be bought for protection against cholera. What were they? Would either of these have been of any use? This is a poster that was put up in London in 1848, during the second outbreak of cholera.

Prevention of Cholera.

REMEDIES RECOMMENDED BY GOVERNMENT.

01. We would urge the necessity, in all cases of Cholera, of an instant recourse to medical aid, and also under every form and variety of indisposition; for, during the prevalence of this epidemic, all disorders are found to merge in the dominant disease.

02. Let immediate relief be sought under disorder of the bowels, especially, however slight. The isolation of Cholera may thus be readily and at once prevented.

03. Let every impurity, animal and vegetable, be quickly removed to a distance from the habitations: such as slaughter-houses, pig-sties, cesspools, necessaries, and all other domestic nuisances.

04. Let all uncovered drains be carefully and frequently cleaned.

05. Let the grounds in and around the habitations be drained, so as efficiently to carry off moisture of every kind.

06. Let all partitions be removed from within and without habitations, which unnecessarily impede ventilation.

07. Let every room be daily thrown open for the admission of fresh air, and this should be done about noon, when the atmosphere is most likely to be dry.

08. Let all washing be used in domestic cleansing, in place of water cleansing.

09. Let excessive fatigue and exposure to damp and cold, especially during the night, be avoided.

10. Let the use of cold drinks, and cold liquors, especially under fatigue, be avoided, or when the body is heated.

11. Let the use of cold acid fruits and vegetables be avoided.

12. Let excess in the use of alcohol and fermented liquors and tobacco be avoided.

13. Let a pure diet, and the use of impure water in cooking, or for drink, be avoided.

14. Let the wearing of wet and insufficient clothing be avoided.

15. Let a flannel or woollen belt be worn round the body.

This has been found serviceable in checking the tendency to bowel complaint so common during the prevalence of Cholera. The disease has, in this country, very rarely been known to commence with lesions in the bowels, and in this stage is very treatable. It should, however, be noticed, that the lesions are frequently unnoticed by pain or weakness, and final death has often occurred from the notion that cholera must be attended with cramps. In the earlier stages, however, there is often no growing symptom, and it is at this point that the disease can be most easily arrested. (In all such cases it is from twenty to forty drops of Dr. J. F. Trench's Cholera Tincture to be administered in half a glass of brandy, and the symptoms will subside immediately.)

16. Let persons cleanly be carefully observed.

17. Let every cause tending to depress the moral and physical energies be carefully avoided.

18. Let crowding of persons within houses and apartments be avoided.

19. Let sleeping in low and damp rooms be avoided.

20. Let fires be kept up during the nights in sleeping or adjoining apartments, the night being the period of most danger from attack, especially under exposure to cold or damp.

21. Let all bedding and clothing be daily exposed during winter and spring to the fire, and in summer to the heat of the sun.

22. Let the dead be buried in places remote from the habitation of the living.

By the timely adoption of simple means such as these, Cholera, or any other epidemic, will be made to lose its venom; it is true that internal sanitary arrangements, and not preventive and sanitary laws, are the safeguard of nations.

Every one should provide themselves with the Anti-Cholera Tincture, as the most ready and efficient remedy in Cholera, Puerperal, Dysentery, Cholera, and Bubonic Complaints.

In Bottles at 2s. 6d.—4s. 6d.—1s. 6d., and 2s. Duty included.

The Anti-Cholera Elixirs, for purifying the Air of Dwellings, and destroying the Contagious influence of Cholera, Typhus Fever, and other Infectious Diseases.

They are particularly recommended for the Sick Chambers, Hospitals, Churches, Chapels, Literary Institutions, Theatres, Assembly Rooms, Counting Houses, Factories, the Cabin and Mode of Vessels, &c.

In Boxes, at 6d.—1s. 6d., and 2s. each, or Carriage Free, at 1s.—1s. 6d. and 2s.

Packages for Extensive Buildings, at 10s.—20s.—40s., and 60s.

ANTI-CHOLERA TINCTURE DEPOT.

41, COLEMAN STREET, CITY, LONDON.

N.B. Money Orders must be made payable to Dr. Jacques Lemoine.

(PRO ref: MH 13/245)

http://www.learningcurve.gov.uk/victorianbritain/healthy/source3.htm Source 4

Task

4a Where does he say the worst outbreaks of cholera took place?

4b Where were there not many, if any, cases of cholera?

4c How does he explain the differences?

4d What does he believe were the causes of cholera?

4e Do you think that people in 1848 had any better idea of the ways to treat cholera than they had had in 1832? (Source 1)

4f If all the suggestions made in source 3 and 4 had been followed, would this have prevented an outbreak of cholera?

Source 4

In October 1848 this letter was written to the General Board of Health (set up by the Public Health Act 1848). The writer is describing the cholera epidemic of 1832 which he had witnessed.

http://www.learningcurve.gov.uk/victorianbritain/healthy/source4.htm Cholera— influenced by bad and stagnant water which absorbs the poison.

24 High Street, Marylebone 19th October 1832

My Lord,

I have found myself the honours to address a letter to Your Lordship bearing date the 29th August last, to the attention I had paid to the Cholera during the year 1832, and I now crave the indulgence of offering an opinion founded upon the observations I then made, which may in some measure serve to carry out the views of the Legislature.

In a port and other towns in the immediate vicinity of River and Canal, built on marshy ground, even principally visited by the Cholera, and it was remarkable that the supply of water at these places was obtained from ponds or sluggish streams, and of a very impure quality, whilst those on the adjacent hills or mountainous country escaped its ravages. I noticed this fact more particularly in France, as the mortality was very great at Calais. Caesar, St. George, Guineas and St. Omer, but in the intermediate County being a succession of hills were populated and forming a circumference of many miles there was not a death arising from Cholera. At the City of Bristol a fourth of which is built on the marshes through which the River Avon and the floating docks pass the cases of Cholera were very numerous, whilst the other parts rising to very high ground, and well supplied with spring water were very free from it.

It is now generally admitted by the medical profession, and by other scientific bodies that the Cholera is not contagious, but that the atmosphere travels in a poisoned state, the inhaling of which does not produce Cholera, and my impression is that it chemically infects exposed water in a gaseous state, and the poorer classes using such water as a beverage and partaking of it in their food are consequently the greatest sufferers. The same places as in 1832 no doubt will be revisited by the cholera if there should not have been any improvement in the supply of water.

Streets and houses vapours will generate Typhus and putrid Fever, but those earlier I am emboldened to state will not predispose to the disease of Epidemic Cholera.

With the highest respect,

I have the honour to be,

My Lord,

Your Lordship's most obedient and very humble servant,

[Signature]

The Right Honble The Earl of [Name] Source 5

Task

5a How many people had signed the petition in Ormskirk?

5b What are the reasons for sending the letter?

5c Which of the reasons would help prevent cholera? Which would not? This is a letter written by the Chairman of the Sanitary Committee of Ormskirk to the General Board of Health in 1848. Towns could ask the General Board to set up a Local Board, but at least ten percent of the ratepayers had to sign a petition. The General Board would then send an inspector to town to inspect the sanitary state of the town. induced our purpose, but foreseeing that there is no sufficient available power of dealing summary with such lodgings started which have become from our necessity to Liverpool quite a field to the town it will await better, as a permanent remedy. The remedies being too and an ample supply of water without which no efficient sanitary measure can be carried out. The attendance of an officer is only as practicable as currently requested in the meantime. I am at Chairman of the Sanitary Committee, under the direction of the Guardians and at the order of the Commissioners as far as practicable. I shall be glad to give the publicity to the instructions of the efficient attendance to make the necessary enquiry and shall be glad of any information to enable the Board here as best engaged. Perhaps you will inform what the surveying officers will make the necessary enquiry for himself or he will expect the Subscribers to prepare in the meantime for the Enquiry.

Sam. W. Yarow, my Secretary

[Signature]

15 Oct. 1848

(PRO ref: MH13/138) Source 6

Task

6a What was the inspector going to look into?

6b Would his enquiries have helped to identify possible causes of cholera outbreaks in the town?

Look back at source 5

6c In what ways do these sources suggest that cholera was being taken more seriously in Britain? This poster appeared in the town of Ormskirk in Lancashire in October 1848. It was signed by the inspector appointed for Ormskirk.

PUBLIC HEALTH ACT, 1848.

WHEREAS, in pursuance of the Public Health Act, 1848, the General Board of Health have directed Robert Rawlinson Esquire, one of the Superintending Inspectors appointed for the purposes of the said Act to visit the Town and Township of Ormskirk in the County of Lancashire and there to make public enquiry and examine witnesses with respect to the matters following; that is to say,

- The Sewerage, Drainage, and Supply of Water.
- The State of the Burial Grounds.
- The Number and Sanitary Condition of the Inhabitants.
- The Local Acts of Parliament (if any) for Paving, Lighting, Cleansing, Watching, Regulating, Superseding with Water, or Improving, or having relation to the purposes of the said Act.
- The natural Drainage Areas.
- The existing Parish or other Local Boundaries.
- The Boundaries which may be most advantageously adopted for the purposes of the said Act.

And other matters in respect whereof the General Board of Health is desirous of being informed for the purpose of enabling them to judge of the propriety of reporting to Her Majesty or making a provisional order with a view to the application of the said Act, or any part thereof to the said Town and Township.

Now, therefore, I, the said Robert Rawlinson, do hereby give notice, that on the first day of November next, at Eleven o’Clock in the forenoon, at the Town Hall, I will proceed upon the said enquiry, and that I shall then and there be prepared to hear all persons desirous of being heard before me upon the subject of the said enquiry.

Dated this Twenty-third day of October 1848.

Robert Rawlinson

(PRO ref: MH 13/138)

http://www.learningcurve.gov.uk/victorianbritain/healthy/source6.htm Source 7

Task

7a. Why was this petition sent? What were the people objecting to?

7b. Why do they believe that a Local Board of Health is not needed?

A petition sent by people in Ormskirk to the General Board of Health.

http://www.learningcurve.gov.uk/victorianbritain/healthy/source7.htm Source 8

Task

8a. What is the main reason for the outbreak of cholera suggested in this source?

8b. What conditions in Newcastle upon Tyne and Gateshead caused cholera to spread so easily?

8c. The end of the source says that some men are against efforts to improve living conditions in the worst parts of the city. Can you explain this? This is part of newspaper report from October 1853; this was at the time of the third outbreak of cholera.

PRECAUTIONS AGAINST CHOLERA.

The advanced scientific information of the day shows that Cholera and Fever are as capable of being prevented as that once fatal malady the Small-pox. By the introduction of Vaccination, the latter complaint has been driven from amongst the higher and more intelligent classes of the community. Cholera (that new plague) can also be prevented by proper sanitary arrangements. This dreadful pestilence has for the third time visited our shores; on two former occasions, it has gone nearly over the same ground; it then seized on those places remarkable for their ill-judged position, or from the great neglect of means of cleanliness, adequate to extent and progress of the population.

Since the last visitation of Cholera, Newcastle-upon-Tyne and Gateshead have made but little improvement in their condition, the numbers of persons have increased, particularly amongst the poor. The houses in many instances are so peculiarly placed that the one catches the refuse of the other. The river Tyne is even polluted with filth; and, without entering into distressing particulars, these towns were in 1853 the ready vehicle to convey this scourge once more to England. The pestilence has passed over its regular course. Who can say if Newcastle had been put into a proper state of defence to meet the enemy which will sweep away many thousands, this island might not have altogether escaped the visitation. The Plague, before the Fire of 1666, found constant harbour in London, and spread itself in different directions. After the Fire it only slightly attacked the metropolis and was speedily banished from the country.

We do not mean to state that the disease so fearfully known by the them and their families in a wholesome manner, at a small yet remunerating cost.

A worse sanitary state of things could not well be than that in the neighbourhood of the Coal-yard, Drury-lane. Here are from sixteen to eighteen large families living in small, inconvenient apartments, above cow-sheds, donkey and horse stables, &c. Sometimes many cart-loads of refuse are allowed to remain in the yard; the pavement is uneven, and filled here and there with stagnant water. It is shocking to see the squalid children attempting to play in such a place; and yet this place is within a stone's throw of the spot on which the Great Plague broke out, as may be seen by reference to the Parish-clerk's Reports, the Diaries of Evelyn and Pepys, and Dr. Foe's Account of the Plague.

To the miserable condition of this filthy place, called "King's Arm-yard," attention has been lately called. The residences, in a sort of gallery, are ranged about what has been one immense retting dung-heap. Some efforts have been made to improve its condition; and there has been carted out of it a mass of decomposed filth, the stench of which was scarcely endurable. Close to this spot, the approach to which from Drury-lane has now, appropriately enough, a coffin-maker's shop on each side, the Great Plague of 1665 broke out; and here neglect, ignorance, and laissez-faire prepare the way for a fresh pestilence. Most deeply is it to be regretted that at such a time as the present men should be found to lend the weight of an official position to obstruct endeavours to obtain improvement in the neglected portions of this two-sided metropolis, instead of giving their earnest aid, as they should do, in furtherance of them.

(PRO ref: ZPER 34/23)

http://www.learningcurve.gov.uk/victorianbritain/healthy/source8.htm